Nicki Rayment is Head of Digital Services at Cornwall Partnership NHS Foundation Trust, a Community and Mental Health Trust covering Cornwall and the Isles of Scilly. She tells Johanna Hamilton AMBCS, about digital transformation within the NHS, over her 29 years of working for our national treasure and why there is much to be happy about with diversity.

Tell me about how the NHS has changed during your career?

This is year 29 for me in the NHS. When I started, technology was still very much based around mainframe and green screen systems for patient administration and lab systems. At that time, we probably had no more than about twenty desktop computers across the whole of the hospital, and most documentation was still done on electronic typewriters.

The use of technology in the NHS has moved from something that was quite niche and people were apprehensive of, to something that is intrinsic to the everyday function of the NHS and it’s hard to see how we could function without technology now. The emerging use of artificial intelligence to improve prevention and diagnosis and the use of robotics in health care are both fascinating and exciting.

Across the NHS there are numerous clinical systems which support patient care, quite often these are unique to individual organisations. In the early 2000s the National Programme for IT planned for us all to be on just a handful of clinical systems and for those systems to talk to each other. That didn’t happen.

However, it did lead to the existence of the Spine which allows NHS organisations to have a single reference point for everyone with an NHS number. We also have the NHS Summary Care Record, which is fed from GP systems across England and provides access to specific information, such as prescribed medications and allergies.

This is great for Cornwall with its influx of holiday visitors. It means if you need health care whilst on holiday clinicians can, with your permission, access this information about you in seconds to support your care.

Why didn’t the full transformation happen?

The NHS, as you’re probably aware, isn’t just one organisation, it’s lots of separate organisations, all slightly different offering different services and commissioned in different ways. From this aspect the one size fits all approach of the National Programme didn’t work.

The challenge for the NHS now is to achieve the same outcome through interoperability. The Local Health and Care Records Programme is focussed on connecting existing systems together to facilitate a single view of a patients’ health and care record. Technology in the NHS can be a dichotomy.

In one organisation you can find areas that are making use of modern technology, such as robotics for dispensing medicines. In the same organisation there can be legacy systems, such as older patient administration systems, that can’t or struggle to meet the current interoperability standards.

How does GDPR work within that environment?

The NHS has long established approaches to consent. Patients are always asked whether they consent to share information with others involved in their care. For example, let’s take health visitor and midwifery services. So, the midwifery service will be in the acute hospital, you’ve had a baby but they’ve got to pass that information to your health visitor and the health visitor works in a community setting.

There will be an information sharing agreement in place between those organisations to support that happening. In terms of GDPR we haven’t seen too much impact because we always had this culture in place anyway. We also have the concept of legitimate relationships between a healthcare professional and a patient.

This means if a clinician has no direct responsibility for your care, then they will be asked to justify why they are accessing your electronic health record. The duty to share information can be as important as the duty to protect patient confidentiality.

It is it changing? Can you tell me about how apps are changing the NHS?

As the health and care system as a whole moves towards a preventative approach, there is a swing towards increased use of technology to promote health, wellbeing and self-management. People today will be faced with a myriad of apps that could support their health and care, but how can people tell which ones are good? To help with this, the NHS Apps Library has been launched to assist patients, public and NHS staff find trusted health and wellbeing apps.

These include free apps but also those that clinicians may prescribe as part of a care pathway, for example apps have been developed for chronic conditions such as COPD (Chronic Obstructive Pulmonary Disease) which when used as part of a care pathway with a clinical team can help to support keeping people well in their own home rather than them coming into a clinical care setting.

The NHS App has been launched this year. Although its early days yet, eventually this will offer a way for patients to securely access a range of health services. This includes accessing their own health records, booking clinical appointments and so on.

Have you been involved in any transformative projects?

Plenty. The most significant ones for me, are where we’ve moved from paper records to electronic records. I’ve done that in a couple of organisations, moving from old paper case notes being stored and moved around hospitals and health care settings, onto an electronic record that is accessible wherever it’s needed by the clinician.

Whenever we talk with clinicians their biggest challenge is what they term the ‘the 3am test’. This is when they are on-call and they need to treat a person in crisis or unwell, where do they go to find the information they need? Moving to an electronic record lets them do that quickly and from any location.

What is the biggest lesson you’ve learned in your role?

Things being difficult isn’t a reason not to do them. Quite often, with technology, you’ll go into a situation where there’s a challenge of ’oh we tried that before, it didn’t work,’ or ’we don’t want to do it.’ Many systems have intricately evolved over a long period of time, so when you need to make a big change it feels really difficult. I suppose my biggest lesson is don’t use a sticking plaster. If it needs to change, however difficult it’s going to be, do it now because it will be harder in five years’ time.

What advice would you give to a CIO trying to do their own transformation project?

Engage with people. Get out and about and keep talking and listening. Keep asking how we can make it better. People will say, ‘oh, the IT system’s rubbish.’ Okay, but what’s rubbish? What’s not working? Because we can usually make it better, but we can only make it better if you can tell us what’s wrong with it. Understand how it’s used and how the system feels to them. It might be great for us, but when you’re a community nurse who’s out and about in a rural area with no signal it’s a completely different world.

So, there’s an NHS Leadership Academy to actually encourage people to learn?

Absolutely. The NHS Leadership Academy offers opportunities for all levels of staff across the NHS to develop. Last year the new NHS Digital Leadership Academy was launched, this is a real positive leap forward and will help to support current and future digital leaders in the NHS. Alongside this Health Education England is promoting a digital literacy programme to encourage all NHS staff to think about their own digital skillset. I’ve felt really supported in the NHS.

The investment in my continuing education has meant that I’ve been loyal to the NHS. If you want to work in IT, then the NHS has so many opportunities for you. It’s not just about qualifications though, we also need to see IT as a profession. This is one of the reasons why we’ve invested in BCS corporate membership, it opens up avenues for people to develop professional networks and achieve recognised standards such as RITTech.

Are there any barriers for women who want to work in IT, in the NHS?

I’ve been really fortunate in that I’ve never felt discriminated against being a woman. When I came into IT at the NHS in 1990 there were fewer women than men and I think that for some of the more technical facing roles then women do number 20% or less of the workforce. However, within my team, there’s more of a 50/50 split. I think this is generally because of how many women have moved into their roles - administrators of paper records have had to migrate to digital systems and quite often become the system administrators of these.

The modern digital services department is not comprised of just technical engineers; we have system administrators, project managers, trainers, web developers, transformation leads - it’s about finding people’s strengths and building on those. It’s not necessarily a prerequisite to have a technology related qualification.